Is the future in the cards?

Smart cards have yet to catch on in health care. Applications for data security and marketing, however, could boost their use.     

Does the Heartbeat Award scheme in England result in change in dietary behaviour in the workplace?

The Heartbeat Award (HBA) scheme is a national nutrition labelling scheme that operates throughout England. The aim of this study was to assess whether the implementation of the HBA scheme in the workplace results in an improvement in eating habits at work. A longitudinal survey of employees using a structured questionnaire pre- and post-HBA intervention in six workplaces in Leicestershire, England, was conducted. A qualitative food frequency questionnaire was used to assess dietary behaviour 6 months before the scheme was implemented and 6 months afterwards. Four HBA workplaces (n = 453 employees) were compared with two comparison workplaces (n = 124 employees). The outcome measures for dietary change were consumption of 20 food items, i.e. 16 food-frequency and four food-type items. Changes in pre-intervention data compared with post-intervention data evaluated the impact of the HBA on eating habits. Differences were considered statistically different at the p < 0.05 level. Crude and adjusted odds ratios were used to assess differences in change in dietary behaviour between the intervention and comparison workplaces. The results showed that there was significantly more positive change in intervention workplaces only (i.e. the changes were not detected in the comparison workplaces) for four of the 20 food items tested: increase in consumption of fruit (p = 0.029); reduction in consumption of fried foods (p = 0.044) and sweet puddings (p = 0.042); and change to lower fat milks (p = 0.034). In conclusion, the HBA had a modest impact on dietary intake, resulting in a significant positive change in four out of 20 foods consumed by employees in HBA-holding premises.     

Health promotion in the occupational setting: what are the prospects in the Italian situation?

Over the past decades advances in sciences and medicine have improved living and health conditions and lengthened life expectancy. These benefits are associated with an increase in prevalence of chronic degenerative diseases. With their multi-factorial aetiology these diseases are influenced by life styles and personal habits and require prolonged medical care and high social costs. Now days health is no longer considered as the absence of disease but a state of mental, physical and social well-being. The World Health Organization has defined health promotion as "the process of enabling people to increase control over and to improve health". Since the 70s in the USA many health promotion programmes have been proposed, especially by large corporations, in order to ensure a more efficient, productive and motivated work-force, to reduce health insurance costs and to provide a better company image. Workplaces,--particularly when the working population is relatively stable--are excellent areas for health promotion programmes because workers can be monitored over a long period of time. The most successful programmes are aimed at modifying behaviour in risk patterns (smoking, alcohol abuse, eating disorders, etc.) through information, active participation, screening, follow-up, personalized programmes, changes in the working environment, physical exercise programmes. These health promotion programmes are extremely hard to develop for Italian workers. Most firms are small or very small and much still remains to be done to eliminate well-known occupational risk factors. The current flexibility of modern work patterns could constitute a further obstacle.     

Nutritional Support in the ICU

Starvation is not a desirable part of the treatment in the ICU.This is in particular true for patients with preexisting disease and perhaps malnutrition already when entering the unit.In addition critical illness in itself imposes a high metabolic demand upon the patient. Inparticular protein metabolism is dramatically altered in order to provide a metabolic state which gives the criticall ill patients the best possilbilities for survival and recovery. This priority is given at the expense of in particular skeletal musele proteins, which are sacrificed during crit     

Is the self of the infant preserved in the adult?

Medicine, Health Care and Philosophy - What does a confrontation between philosophy and psychoanalysis look like? My task is a philosophical investigation of a psychoanalytic concept. Thus, I offer...     

Was there a disparity in age appropriate infant immunization uptake in the theatre of war in the North of Sri Lanka at the height of the hostilities?: a cross-sectional study in resettled areas in the Kilinochchi district

Background

It was long speculated that there could be under-immunized pockets in the war affected Northern part of Sri Lanka relative to other areas. With the cessation of hostilities following the military suppression of the rebellion, opportunities have arisen to appraise the immunization status of children in areas of re-settlement in former war ravaged districts.

Methods

We conducted a cross-sectional study to describe the coverage and age appropriateness of infant vaccinations in a former conflict district during the phase of re-settlement. The target population comprised all children of re-settled families in the age group of 12 – 23 months in the district. We selected a study sample of 300 children from among the target population using the WHO’s 30 cluster EPI survey method. Trained surveyors collected data using a structured checklist. The infant vaccination status was ascertained by reviewing vaccination records in the Child Health Development Record or any other alternative documentary evidence.

Results

The survey revealed that the proportion of fully vaccinated children in the district was 91%. For individual vaccines, it ranged from 92% (measles) to 100% (BCG, DPT/OPV1). However, the age appropriateness of vaccination was less than 50% for all antigens except for BCG (94%). The maximum number of days of delay of vaccinations ranged from 21 days for BCG to 253 days for measles. Age appropriate vaccination rates significantly differed for DPT/OPV1-3 and measles during the conflict and post-conflict stages while it did not for the BCG. Age appropriate vaccination rates were significantly higher for DPT/OPV1-3 during the conflict while for the measles it was higher in the post conflict stage.

Conclusions

Though the vaccination coverage for infant vaccines in the war affected Kilinochchi district was similar to other districts in the country, it masked a disparity in terms of low age-appropriateness of infant immunizations given in field settings. This finding underscores the need for investigation of underlying reasons and introduction of remedial measures in the stage of restoring Primary Health Care services in the ex-conflict zone.

     

Emerging literacy during ‘Day in the Life’ in the transition to school

The transition to school, marked by significant moves towards print literacy, is a crucial school-life milestone that can be both exhilarating and daunting. This case study, extracted from an international, quasi-ecological examination of thriving kindergarten children in transition to school films participants, their families, schools and communities during one ‘day in their lives’. We monitored one Canadian child's transaction with her interlocutors as she negotiated a day in her life from arising to bedtime. All literacy-related interchanges were identified, and three exemplary exchanges were selected, analysed and contextualised, applying Cameron and Pinto's [(2009). Day in the life: Secure interludes with joint book reading. Journal of Research in Childhood Education, 23(4), 437–449. doi:10.1080/02568540909594672] taxonomy to: one child/school-teacher, one child/music instructor and one child/parent joint text-reading transaction. Capturing her engagement in meaning-making as she experienced different expectations and interaction styles we examined the continuities/discontinuities supporting her negotiation of those experiences.     

What accounts for the regional differences in the utilisation of hospitals in Germany?

There are huge regional variations in the utilisation of hospital services in Germany. In 2007 and 2008 the states of Hamburg and Baden-Württemberg had on average just under 38 % fewer hospitalisations per capita than Saxony-Anhalt. We use data from the DRG statistics aggregated at the county level in combination with numerous other data sources (e.g. INKAR Database, accounting data from the National Association of Statutory Health Insurance Physicians (KBV), Federal Medical Registry, Germany Hospital Directory, population structure per county) to establish the proportion of the observed regional differences that can be explained at county and state levels. Overall we are able to account for 73 % of the variation at state level in terms of observable factors. By far the most important reason for the regional variation in the utilisation of in-patient services is differences in medical needs. Differences in the supply of medical services and the substitutability of outpatient and inpatient treatment are also relevant, but to a lesser extent.     

Is the apparent decrease in injury and illness rates in construction the result of changes in reporting?

Injury rates in all industries and in construction in particular have been declining. Inconsistencies in the information suggest some of the apparent decrease may be due to changes in the ways injuries are treated, misclassification of employees, or underreporting. Lost-time injury rates for the largest construction employers declined by as much as 92% between 1988 and 1999. Yet the rate for cases with restricted work activity actually increased from 0.7 to 1.2 per 100 full-time workers between 1990 and 2000, and fatalities among construction workers remain high. In Massachusetts, at least 14% of construction employers misclassified workers as independent contractors, with the effect that injuries to these workers are not recordable. Studies that compare OSHA logs with other data sources find that the OSHA logs do not include a significant proportion of injuries and illnesses identified elsewhere.     

Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring?

A number of cross-sectional and prospective studies suggested a priming effect of maternal smoking in pregnancy on offspring’s obesity. It has been hypothesized that this association might be explained by low birth weight and subsequent catch-up growth in the causal pathway. We therefore examined the role of birth weight in children exposed versus not exposed to cigarette smoking in utero on later body mass index (BMI). Using data of 12,383 children and adolescents (3–17 years of age) recorded in a German population-based survey (KiGGS), we assessed mean body mass index standard deviation scores (BMI-SDS) in different birth weight SDS categories, stratified for children with smoking and non-smoking mothers. We calculated spline regression models with BMI-SDS as outcome variable, cubic splines of birth weight SDS, and potential confounding factors. Children whose mothers had been smoking during pregnancy had lower birth weight SDS and higher BMI-SDS at interview compared to children of non-smoking mothers. However, we observed a linear association between birth weight SDS and BMI-SDS in crude analyses for both groups. Similarly, almost linear effects were observed in adjusted spline regression analyses, except for children with very low birth weight. The respective 95% confidence bands did not preclude a linear effect for the whole birth weight SDS distribution. Our findings suggest that low birth weight is unlikely to be the main cause for the association between intrauterine nicotine exposure and higher BMI in later life. Alternative mechanisms, such as alterations in the noradrenergic system or increased food efficiency, have to be considered.     

Listening and dialogue in pre-natal assistance in the region surrounding the south zone, in the municipal district of São Paulo

A transversal study was carried out to verify the importance of dialogue and of listening in the care provided to pregnant women, participants of the pre-natal program in four basic Health Units: two of them, using a traditional model and two using the Family Health Program (PSF) model, located at the Subprefeitura (administrative region) of Capela do Socorro, Sao Paulo. The objective was to identify the perceptions of the pregnant women related to listening and dialogue offered by the pre-natal team. A sample was randomly taken from 50% of the pregnant women that were in the third month of attendance. For the 152 participants, a self-applicable and semi-structured questionnaire with some opened questions was used, developed after prior testing. Cochran's G and Chi-square tests were used for a statistical analysis. The number of pregnant women that received guidance regarding the program working method was greater in the Icaraí Traditional Unit. It has been observed that the pregnant woman are heard and there is dialogue during pre-natal care both in the Traditional Units and those in the Family Health Program ( PSF), suggesting that in the two health care models excellent Public Health Care Work can be offered.